An Operative Case of Solitary Metastatic Carcinoma of the Small Intestine Presenting as Small Bowel Obstruction 4 Years and 9 Months after Curative Resection of Gastric Carcinoma

Hidenobu Okino, Yuji Shinagawa, Soichi Yoshitomi, Jiro Watanabe* and Shigeaki Takeda

Department of Surgery and Clinical Research and Department of Pathology*, National Hospital Organization, Kokura Hospital

An 82-year-old man who had undergone distal partial gastrectomy for gastric carcinoma 4 years and 9 earlier admitted for small bowel obstruction was found in enhanced CT to have a tumor 4 cm in diameter in the ileum. Swallowing of meglumine amidotrizoate (Gastrografin) showed a tumor in the ileum. The jejunum (about 60 cm), bladder, and sigmoid colon was resected because the tumor had invaded the bladder and sigmoid colon. Pathological findings showed that the tumor was mainly located between the small intestine and bladder. Pathological features strongly resembled those of the specimen from the first operation, leading to diagnose this tumor as metastatic tumor from gastric carcinoma. Few cases are reported as solitary metastatic carcinoma of the small intestine, such as in this case, because the majority of metastatic carcinoma of the small intestine involves direct invasion and peritoneal dissemination of malignant tumors in the abdomen. Solitary metastatic carcinoma of the small intestine, which is clinically presented as acute abdomen such as perforation, intussusception, ileus and intestinal bleeding, should be considered as a differential diagnosis after malignant tumor operation.

Key words
solitary metastatic carcinoma of small intestine, small bowel obstruction, gastric carcinoma

Reprint requests
Hidenobu Okino Department of Surgery and Clinical Research, National Hospital Organization, Kokura Hospital
10-1 Harugaoka, Kokuraminami-ku, Kitakyush, 802-8533 JAPAN

Accepted
June 22, 2005

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